Provider Demographics
NPI:1699228684
Name:RICHARDSON, DANIELLE LYNN (RPT)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:LYNN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18629 TAMPA RD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33967-3530
Mailing Address - Country:US
Mailing Address - Phone:239-634-4418
Mailing Address - Fax:
Practice Address - Street 1:8900 TAMIAMI TRL N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-2535
Practice Address - Country:US
Practice Address - Phone:239-597-8196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT60485183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician